Affliction
Consequences of Routine Work-Schedule Instability for Worker Health and Well-Being
Daniel Schneider & Kristen Harknett
American Sociological Review, February 2019, Pages 82-114
Abstract:
Research on precarious work and its consequences overwhelmingly focuses on the economic dimension of precarity, epitomized by low wages. But the rise in precarious work also involves a major shift in its temporal dimension, such that many workers now experience routine instability in their work schedules. This temporal instability represents a fundamental and under-appreciated manifestation of the risk shift from firms to workers. A lack of suitable existing data, however, has precluded investigation of how precarious scheduling practices affect workers’ health and well-being. We use an innovative approach to collect survey data from a large and strategically selected segment of the U.S. workforce: hourly workers in the service sector. These data reveal that exposure to routine instability in work schedules is associated with psychological distress, poor sleep quality, and unhappiness. Low wages are also associated with these outcomes, but unstable and unpredictable schedules are much more strongly associated. Precarious schedules affect worker well-being in part through the mediating influence of household economic insecurity, yet a much larger proportion of the association is driven by work-life conflict. The temporal dimension of work is central to the experience of precarity and an important social determinant of well-being.
Funding for Abstinence-Only Education and Adolescent Pregnancy Prevention: Does State Ideology Affect Outcomes?
Ashley Fox et al.
American Journal of Public Health, March 2019, Pages 497-504
Methods: We modeled time-series data on federal abstinence-only and adolescent pregnancy–prevention and sexuality education block grants to US states and rates of adolescent births (1998–2016) and adjusted for state-level confounders using 2-way fixed-effects models.
Results: Federal abstinence-only funding had no effect on adolescent birthrates overall but displayed a perverse effect, increasing adolescent birthrates in conservative states. Adolescent pregnancy–prevention and sexuality education funding eclipsed this effect, reducing adolescent birthrates in those states.
Conclusions: The millions of dollars spent on abstinence-only education has had no effect on adolescent birthrates, although conservative states, which experience the greatest burden of adolescent births, are the most responsive to changes in sexuality education–funding streams.
The Roots of Health Inequality and The Value of Intra-Family Expertise
Yiqun Chen, Petra Persson & Maria Polyakova
NBER Working Paper, February 2019
Abstract:
Mounting evidence documents a stark correlation between income and health, yet the causal mechanisms behind this gradient are poorly understood. This paper examines the impact of access to expertise on health, and whether unequal access to expertise contributes to the health-income gradient. Our empirical setting, Sweden, allows us to shut down inequality in formal access to health care; we first document that strong socioeconomic gradients nonetheless persist. Second, we study the effect of access to health-related expertise – captured by the presence of a health professional in the extended family – on health. Exploiting “admissions lotteries” into medical schools and variation in the timing of degrees, we show that access to intra-family medical expertise has far-reaching health consequences, at all ages: It raises longevity, improves drug adherence and reduces the occurrence of lifestyle-related disease in adulthood, raises vaccination rates in adolescence, and reduces tobacco exposure in utero. Third, we show that the effects of expertise are larger at the lower end of the income distribution – precisely where access to expertise is scarcer. Unequal access to health-related expertise can account for as much as 18% of the health-SES gradient, and may thus play a significant role in sustaining health inequality.
Unequal hopes and lives in the USA: Optimism, race, place, and premature mortality
Carol Graham & Sergio Pinto
Journal of Population Economics, April 2019, Pages 665–733
Abstract:
The 2016 election highlighted deep divisions in the USA, and exposed unhappiness and frustration among poor and uneducated whites. The starkest marker of this unhappiness is the rise in preventable deaths and suicides among the middle aged of this cohort. In contrast, minorities have much higher levels of optimism, and their life expectancies continue to rise. Low-income respondents display the largest differences, with poor blacks by far the most optimistic, and poor rural whites the least. African Americans and Hispanics also have higher life satisfaction and lower stress incidence than poor whites. The gaps across racial groups peak in middle age, at the nadir of the U-curve of age and life satisfaction. We explored the association between our subjective well-being data and the Centers for Disease Control and Prevention (CDC) mortality data. We find that the absence of hope among less than college-educated whites matches the trends in premature mortality among 35–64-year-olds. Reported pain, reliance on disability insurance, low labor force participation, and differential levels of resilience across races all have mediating effects in the desperation-mortality associations. We also explore the role of place, and map the states associated with higher/lower indicators of well-being for these different cohorts. The matches between indicators of well-being and of mortality suggest that the former could serve as warning indicators of ill-being in the future, rather than waiting for rising mortality to sound the alarms.
Educational Disparities in Adult Health: U.S. States as Institutional Actors on the Association
Jennifer Karas Montez, Mark Hayward & Anna Zajacova
Socius: Sociological Research for a Dynamic World, March 2019
Abstract:
Despite numerous studies on educational disparities in U.S. adult health, explanations for the disparities and their growth over time remain incomplete. The authors argue that this knowledge gap partly reflects an individualist paradigm in U.S. studies of educational disparities in health. These studies have focused largely on proximal explanations (e.g., individual behaviors) to the neglect of contextual explanations (e.g., economic policies). The authors draw on contextual theories of health disparities to illustrate how U.S. states, as institutional actors, shape the importance of education for health. Using two nationally representative data sets and seven health measures for adults aged 45 to 89 years, the authors show that the size of the educational gradient in health varies markedly across states. The size varies because of variation in the health of lower educated adults. The authors use state excise taxes on cigarettes to illustrate one way states shape educational disparities in health. These findings underscore the necessity of contextualizing these disparities.
How Does Body Mass Index Affect Economic Growth? A Comparative Analysis of Countries by Levels of Economic Development
Inas Kelly, Nadia Doytch & Dhaval Dave
Economics & Human Biology, forthcoming
Abstract:
The WHO views obesity as a significant risk to population health. Evidence suggests that obesity reduces labor-market attachment, worker productivity, and earnings. This link at the micro level may translate into adverse effects on economic growth at the macro level. Few studies have evaluated how body mass index impacts economic growth across and within countries. This sparse evidence base reflects the lack of consistent data across a broad spectrum of countries and timespan, as well as the empirical difficulties in bypassing endogeneity bias relating to unobserved selection and potential reverse causality between bodyweight and GDP. We address both of these challenges by first assembling a comprehensive panel of data spanning 116 countries over 25 years (1984-2008), and then presenting, to the best of our knowledge, the first empirical study of economic growth and obesiy correcting for endogeneity. Our GMM estimates indicate that, in developed countries, a higher level of BMI has direct negative effects on economic growth in a fully saturated model that controls for levels of human capital. In particular, we predict that the increase in BMI over the time period of analysis may have reduced potential economic growth over this period by between 3.5 to 5.8 percentage points.
Mother’s mental health after childbirth: Does the delivery method matter?
Valentina Tonei
Journal of Health Economics, January 2019, Pages 182-196
Abstract:
The dramatic increase in the utilization of caesarean section has raised concerns on its impact on public expenditure and health. While the financial costs associated with this surgical procedure are well recognized, less is known on the intangible health costs borne by mothers and their families. We contribute to the debate by investigating the effect of unplanned caesarean deliveries on mothers’ mental health in the first nine months after the delivery. Differently from previous studies, we account for the unobserved heterogeneity due to the fact that mothers who give birth through an unplanned caesarean delivery may be different than mothers who give birth with a natural delivery. Identification is achieved exploiting exogenous variation in the position of the baby in the womb at the time of delivery while controlling for hospital unobserved factors. We find that mothers having an unplanned caesarean section are at higher risk of developing postnatal depression and this result is robust to alternative specifications.
Sugar-Sweetened Beverage Consumption 3 Years After the Berkeley, California, Sugar-Sweetened Beverage Tax
Matthew Lee et al.
American Journal of Public Health, April 2019, Pages 637-639
Methods: Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption.
Results: At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = −0.75, −0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes.
Impact of a Municipal Policy Restricting Trans Fatty Acid Use in New York City Restaurants on Serum Trans Fatty Acid Levels in Adults
Melecia Wright et al.
American Journal of Public Health, April 2019, Pages 634-636
Objectives: To estimate the impact of the 2006 policy restricting use of trans fatty acids (TFAs) in New York City restaurants on change in serum TFA concentrations in New York City adults.
Methods: Two cross-sectional population-based New York City Health and Nutrition Examination Surveys conducted in 2004 (n = 212) and 2013–2014 (n = 247) provided estimates of serum TFA exposure and average frequency of weekly restaurant meals. We estimated the geometric mean of the sum of serum TFAs by year and restaurant meal frequency by using linear regression.
Results: Among those who ate less than 1 restaurant meal per week, geometric mean of the sum of serum TFAs declined 51.1% (95% confidence interval [CI] = 42.7, 58.3)—from 44.6 (95% CI = 39.7, 50.1) to 21.8 (95% CI = 19.3, 24.5) micromoles per liter. The decline in the geometric mean was greater (P for interaction = .04) among those who ate 4 or more restaurant meals per week: 61.6% (95% CI = 55.8, 66.7) or from 54.6 (95% CI = 49.3, 60.5) to 21.0 (95% CI = 18.9, 23.3) micromoles per liter.
Conclusions: New York City adult serum TFA concentrations declined between 2004 and 2014. The indication of greater decline in serum TFAs among those eating restaurant meals more frequently suggests that the municipal restriction on TFA use was effective in reducing TFA exposure.
Soda Wars: The Effect of a Soda Tax Election on University Beverage Sales
Rebecca Taylor et al.
Economic Inquiry, forthcoming
Abstract:
We examine how soda sales changed due to the campaign attention and election outcome of a local excise tax on sugar‐sweetened beverages. Using panel data of beverage sales from university retailers in Berkeley, California, we estimate that soda purchases relative to control beverages significantly dropped immediately after the election, months before the tax was implemented in the city of Berkeley or on campus. Supplemental scanner data from off‐campus retailers reveal this result is not unique to the university setting. Our findings suggest soda tax media coverage and election outcomes can have larger effects on purchasing behavior than the tax itself.
The Power of the IUD: Effects of Expanding Access to Contraception Through Title X Clinics
Andrea Kelly, Jason Lindo & Analisa Packham
NBER Working Paper, March 2019
Abstract:
We estimate the effect of Colorado's Family Planning Initiative, the largest program to have focused on long-acting-reversible contraceptives in the United States, which provided funds to Title X clinics so that they could make these contraceptives available to low-income women. We find substantial effects on birth rates, concentrated among women in zip codes within 7 miles of clinics: the initiative reduced births by approximately 20 percent for 15-17 year olds and 18-19 year olds living in such zip codes. We also examine how extensive media coverage of the initiative in 2014 and 2015 altered its reach. After information spread about the availability and benefits of LARCs, we find a substantial increase in LARC insertions, extended effects on births among 15-17 year olds living greater than 7 miles from clinics, and significant reductions in births among 20–24 and 25–29 year olds.
The Costs and Benefits of Caring: Aggregate Burdens of an Aging Population
Finn Kydland & Nick Pretnar
NBER Working Paper, January 2019
Abstract:
Throughout the 21st century, population aging in the United States will lead to increases in the number of elderly people requiring some form of living assistance which, as some argue, is to be seen as a burden on society, straining old-age insurance systems and requiring younger agents to devote an increasing fraction of their time toward caring for infirm elders. Given this concern, it is natural to ask how aggregate GDP growth is affected by such a phenomenon. We develop an overlapping generations model where young agents face idiosyncratic risk of contracting an old-age disease, like for example Alzheimer's or dementia, which adversely affects their ability to fully enjoy consumption. Young agents care about their infirm elders and can choose to supplement elder welfare by spending time taking care of them. Through this channel, aggregate GDP growth endogenously depends on young agents' degree of altruism. We calibrate the model and show that projected population aging will lead to future reductions in output of 17% by 2056 and 39% by 2096 relative to an economy with a constant population distribution. Curing diseases like Alzheimer's and dementia can lead to a compounded output increase of 5.4% while improving welfare for all agents.
Secular changes in body height predict global rates of caesarean section
Eva Zaffarini & Philipp Mitteroecker
Proceedings of the Royal Society: Biological Sciences, 6 February 2019
Abstract:
The massive global variation in caesarean-section (C-section) rate is usually attributed to socio-economic, medical and cultural heterogeneity. Here, we show that a third of the global variance in current national C-section rate can be explained by the trends of adult body height from the 1970s to the 1990s. In many countries, living conditions have continually improved during the last century, which has led to an increase in both fetal and adult average body size. As the fetus is one generation ahead of the mother, the fetus is likely to experience better environmental conditions during development than the mother did, causing a disproportionately large fetus and an increased risk of obstructed labour. A structural equation model revealed that socio-economic development and access to healthcare affect C-section rate via multiple causal pathways, but the strongest direct effect on C-section rate was body height change. These results indicate that the historical trajectory of socio-economic development affects — via its influence on pre- and postnatal growth — the intergenerational relationship between maternal and fetal dimensions and thus the difficulty of labour. This sheds new light on historic and prehistoric transitions of childbirth and questions the World Health Organization (WHO) suggestion for a global ‘ideal' C-section rate.